Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry

BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0-Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7-99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC > or = 15000/microL (OR 2.19) with a PPV of 77.8% (95%CI 40.0-97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age > or = 1 year (OR 2.04), absence of headache (OR 3.01), CSF Glu < 40 mg/dL (OR 3.62) and peripheral WBC < 15,000/microL (OR 1.74) with a PPV of 58.5% (95%CI 42.1-73.7). CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied

Prognostic factors related to sequelae in childhood bacterial meningitis: Data from a Greek meningitis registry

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae.</p> <p>Methods</p> <p>A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model.</p> <p>Results</p> <p>The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3).</p> <p>Conclusions</p> <p>A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.</p

Multivariate analysis of groups of diagnostic factors for the diagnosis of ‘other pathogens’.

<p>Multivariate analysis of groups of diagnostic factors for the diagnosis of ‘other pathogens’.</p

Number of confirmed cases and Case Fatality Rates (CFR) of the most common aetiological pathogens of meningitis throughout 1974–2005.

*<p>group B <i>Streptococcus</i>, <i>Salmonella</i> spp, <i>Streptococcus</i> spp, <i>Pseudomonas aeruginosa</i>, <i>Escherichia coli</i>, <i>Staphylococcus</i> spp, <i>Brucella melitensis</i>, <i>Klebsiella pneumoniae</i>, <i>Acinetobacter anitratus</i>, <i>Enterobacter cloaca</i>, <i>Mycoplasma pneumoniae</i>, <i>Proteus</i> spp, <i>Rickettsiae</i> spp.</p

Frequency of clinical and laboratory findings for specific bacterial pathogen.

*<p>Missing values have been excluded from the analysis.</p

Analysis of various characteristics and clinical features at presentation for the diagnosis of <i>N.meningitidis, S.pneumoniae, H.influenzae</i>, and Others.

<p>Analysis of various characteristics and clinical features at presentation for the diagnosis of <i>N.meningitidis, S.pneumoniae, H.influenzae</i>, and Others.</p

Characteristics of the study population.

<p>Characteristics of the study population.</p

Multivariate analysis of groups of diagnostic factors for the diagnosis of <i>Haemophilus influenzae</i> type b.

<p>Multivariate analysis of groups of diagnostic factors for the diagnosis of <i>Haemophilus influenzae</i> type b.</p

Positive Predictive Values (PPV) of diagnostic factors for the diagnosis of causative pathogens.

<p>Positive Predictive Values (PPV) of diagnostic factors for the diagnosis of causative pathogens.</p

Multivariate analysis of groups of diagnostic factors for the diagnosis of <i>Streptococcus pneumoniae</i>.

<p>Multivariate analysis of groups of diagnostic factors for the diagnosis of <i>Streptococcus pneumoniae</i>.</p